Medicare carriers can no longer add ICD-9 code to claims

Why This Topic Matters

The update affects claim acceptance and the completeness of diagnosis reporting for Medicare billing workflows. It is relevant to organizations that prepare claims, order diagnostic tests, or rely on staff or laboratory backfilling of diagnosis information.

Article Sections

1. CMS program memo update

   Introduces the CMS instruction and its timing, with attention to how it affects Medicare claim processing and related billing workflows.

2. Claims submission and laboratory reporting

   Describes the general requirement for diagnosis information to be provided with claims and discusses how this extends to diagnostic test orders and laboratory claims.

3. ICD-9-CM coding specificity and unknown diagnoses

   Summarizes broader ICD-9-CM guidance on diagnosis specificity and on documenting uncertain or unconfirmed diagnoses.